Methods 3 Final Examination Flashcards
How are the two regions of the cervical spine divided?
-Upper Cervical: C0-C2
-Lower Cervical: C2-C7
What is the most mobile region of the spine and must balance the head atop thin long lever
Cervical
What functional anatomy is involved in C0-C2
-Rectus capitis superior Major (occiput to C2 SP)
-Rectus capitis superior minor (occiput to posterior arch of C1)
-Obliqus capitis superior: TP of atlas to occiput
-Obliqus capitis inferior: SP of axis to TP of atlas
C1-Atlas Characteristics
-No vertebral body
-No spinous process
-Circular inferior facets
-5 degrees of lateral flexion*
C2-Axis inferior facet face ____ and _____ @ ___ degrees
inferior and anterior 45 degrees*
Atlanto-axial joint articulations
Three joints mechanically linked:
1-Atlanto-odontoid joint
2-Atlanto-axial joints
How much rotation does the Atlanta-axial joint contribute to the cervical spine in %
50% (40 degrees)
Atlanto-Occipital ROM
-Flexion/Extension: 25 degrees
-Lateral Bending: 5 degrees
-Rotation: 5 degrees
Neuropathy is disease of the _________
Peripheral Nerve
Radiculopathy is disease of the ________
Spinal Nerve Root
Myelopathy is disease of the _________
Spinal Cord
Cervical Radiculopathy Symptoms
-Neck and Arm Pain
-Onset often follows neck injury
-Past history of multiple bouts with neck pain and minor injuries
-Weakness in hand (Deep ache/Bakody’s)
-Follow Dermatomes
Herniation of the nucleus pulposis accounts for only ____ of cervical cases. Foraminal encroachement cases account for ______
20-25%;70-75%
Cervical compression may _______ the neck and arm pain
Reproduce
Cervical distraction may ____ the arm pain
Lessen
Shoulder depression test may:
Reproduce pain on the side of head deviation
Some patients may report some relief of arm pain by putting the hand behind the head called ________
Bakody’s sign
Treatment Options for Cervical Radiculopathy
-Cervical Manipulation
-Cervical Traction
Typical Complaints of Cervical Myelopathy
-BL clumsiness of the hands
-Difficulty Walking
-Possible Urinary Dysfunction
-Possible Shooting Pains into the arms or legs
Causes of cervical myelopathy
Tumour, herniated disc, and spondylotic sources
Tests for cerebellar function
Lhermitte’s Test
Burner/Stinger
-Sudden onset of burning pain and/or numbness along the lateral arm with associated arm weakness
-Following a lateral flexion injury of the neck/head
Facet Joint/Referred Pain
-Irritation of the facet joints or deep cervical muscles causes a referred pain down the arm
Most common location of Facet Joint/Referred Pain
Outer arm to the hand (C5-7)
Treatment of Facet Joint/Referred Pain
-Manipulation (Preferred)
-Cervical Traction
-Myofascial contribution
Congenital Torticollis
Infant with a fixed asymmetry of the head seen within hours of delivery
Adult Torticollis
Painful spasms of the SCM, with head held in rotation and slight flexion
Pseudotorticollis
Inability to move the head in any direction without pain
Thoracic Outlet Syndrome Symptoms
-Numbness and tingling down inside of the arm to the little and ring fingers
-Worse by overhead activity
-Brachial Plexus/Subclavian Artery compressed
Tests for TOS
Allen’s, Roos, Wright’s, Adsons, Costoclavicular
Treatment of TOS
-Postural Correction,
-Stretch: Pectorals and Scalenes
-Strength: Middle/Lower Trap/Rhomboids ‘
-Trigger point therapy
Code for thoracic spine
M99.02
Code for cervical spine
M99.01
Code for Head (TMJ, ear, soft pallet, occiput)
M99.00
Assisted Prestress (CT)
-Patients head is turned away from the contract
-The spine above the contact segment is rotating away from the contact
Resisted Prestress (CT)
Patients head is turned toward the contact
-Spine above the contact segment is rotating into the contact
Characteristics of Transition Areas
-Chronic degenerative changes
-Where convexity/scoliosis occur
-High incidence of anatomical anomalies
-Dysplasia’s are also encountered
Transitional curvature techniques
-Open the concavity while thrusting into the convexity
Soft Tissue Transitional curvatures
-Prevertebral layer of the deep cervical fascia
-Trapezius, scalene, SCM, and Longus coli
-Subclavian/Brachial plexus
Ribs 1-7: Articulate with the sternum ________ via the costochondral and sternocostal joints
Directly
Ribs 8-10: Attach _____ via the interchondral articulations
Indirectly
Ribs 11/12 are _________
Free-floating
Upper ribs axis lies closed to the ______ plane
Frontal
Lower ribs lies closer to the _____ plane
Sagittal
Assessment of Rib Angle Asymmetry
Calliper
Assessment of the Intercostal spaces
Buckethandle
Codes for Ribs
M99.08
Rib 1 and posterior ribs are coded as
Thoracic spine
Code for 1-2 spinal regions
98940
Code for 3-4 regions
98941
Thoracic bodies have an anterior height ______ less than posterior
1-2mm
Thoracic facet lies ______ coronal and ______ towards Sagittal
60 degrees;20 degrees
Thoracic disc height to body ratio is _____
1:5
Thoracic joint coupling
-IL: Cervical to mid thoracic above T4
-CL: Midthoracic to lumbar T4 down
Common Conditions of Thoracic Region
-Scheurmanns Disease, Compression Fracture, Osteoid Osteoma, Postural/Upper Crossed Syndrome, T4 Syndrome, Maigne’s Syndrome, Herpes Zoster (Shingles)
Average lordotic curve of the neck
30-45 degrees
Active ROM of cervical spine
-Flexion: 60 degrees
-Extension: 75 degrees
-Lateral Flexion: 45 degrees
-Rotation: 80 degrees
5 D’s of Cervical Vascular Injury
Dizziness, Drop Attacks, Diplopia, Dysarthria, Dysphagia,
3N’s of Injury to cervical spine
Nausea, Numbness on one side of face/body, nystagmus
You should ask for permission before palpating or open somebody’s gown
TRUE
